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Benefits

Life Insurance and AD&D Enrollment Form

Use this form to enroll in additional levels of life insurance coverage in addition to the University's 1x annual salary coverage. This form also allows you to enroll in separate AD&D (accidental death & dismemberment) insurance, if desired.

07/01/2014 (revision date)
Click to view form (pdf or doc): Life Insurance and AD&D Enrollment Form
Submission Options
Submit paper form to Employee Benefits Office, 112 Scovell Hall
Email form back to benefits@email.uky.edu